Elevance Health Behavioral Health Provider Quality Manager in Bridgewater, Massachusetts
Behavioral Health Provider Quality Manager
Job Family: Behavioral Health
Type: Full time
Date Posted:Feb 07, 2023
Req #: JR52964
Work Model - Remote/ Hybrid position. (Will require onsite visits with providers and some in person meetings with the team).
Location : Must reside in and be licensed in Massachusetts.
Ideal candidates will be within 30 minute commuting distance of Hamden, Hampshire, Franklin, and Berkshire Counties. (Western Mass)
Hours : Monday - Friday, 8:30am- 5:00pm local time.
Responsible for leading Behavioral Health (BH) provider engagement, with a focus on leveraging the data available to providers and helping to improve the value delivered to Beacon members. Drives BH provider performance improvement year over year through education and data. This role is responsible for local market.
Primary duties may include, but are not limited to:
Establishes relationships and engages with CBHC providers and ensures measurable improvements in clinical and quality outcomes for members.
Builds relationships with internal clinical and quality departments to ensure high quality care to members and achievement of company HEDIS performance.
Implements strategies that meet clinical, quality, and network improvement goals through positive working relationships with providers, state agencies, advocacy groups and other market stakeholders. Meets with providers face to face, telephonically and via Web-Ex.
Acts as a liaison between strategic providers and Beacon clinical, quality, provider strategy, network departments, operations, claims and provider relations to ensure interdepartmental collaboration and coordination of goals and priorities and to support linkages for issue resolution, helping to improve provider experience and overall satisfaction with Beacon.
Supports regional and corporate initiatives regarding Alternative Payment Models (APM), including Value Based Payment (VBP), clinical innovation, and thought leadership transforming provider relationships from transactional interactions to collaborative aggregate data assessment.
Creates and maintains linkages between providers of all levels of care, as well as other community based services and resources to improve transitions of care and continuity of services.
Partners with network providers and Beacon stakeholders to operationalize innovative programs and strategies to improve clinical and quality outcomes. Analyzes provider reports pertaining to cost, utilization, and outcomes, and presents the data to providers and highlights trends.
Identifies data outliers and opportunities for improvement for individual providers.
Identifies high-performing and innovative providers who may be interested in new programmatic or payment models.
Collaborates with regional leadership and network teams to identify providers who are best suited for APMs, preferred provider networks, and/or other aggregate data management programs.
Participates in the identification of opportunities for expansion and development of innovative pilot programs, to include program development, implementation, launch, and efficacy and outcomes measurements.
Contributes to the identification of best practices and integrates high-quality program ideas/designs into the local market to drive high levels of value.
Provides consultation to providers for clinically complex members as applicable.
Surfaces clinical and quality issues to regional clinical and quality teams and participates in helping to address concerns.
Conducts medical record reviews annually or as needed with network providers across all service levels. Assists with provider orientations and provider training events in the region, when applicable.
Minimum Requirements :
Requires Master’s degree or above in Behavioral Health field;
10 years of progressively responsible professional experience in healthcare, with at least 5 of those years in a behavioral health setting, either provider or payer; or any combination of education and experience, which would provide an equivalent background.
Current, valid, independent and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) is required.
Travel may be required.
Managed care experience preferred.
Knowledge of Massachusetts Behavioral Health System
Case Management Experience
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.
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